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MSK > Shoulder + Elbow Injuries > Flashcards

Shoulder + Elbow Injuries Flashcards

1
Q

What is subacromial impingement ?

What often causes

A

Pain and dysfunction due to decreased volume of subacromial space or increased contents
e.g. swollen bursae or increased bone e.g. after injury
Often due to rotator cuff injury

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2
Q

What are the symptoms of subacromial impingement

A

Painful arc in abduction - 60-120 (rotator cuff tear = pain up to 60)
Initially pain free
Pain hanging washing up etc
May subside when end of arch reached

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3
Q

How do you treat subacromial impingmenet

A

NSAID
Steroid injection
Physio
Arthroscopic decompression

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4
Q

What is frozen shoulder / capsulitis and what is worse movement

A 
Very acute shoulder pain 
Passive and active affected 
All movement affected
External rotation worse than internal / abduction 
Then becomes stiff
Gradually over 2 years ROM returns
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5
Q

How do you diagnose frozen shoulder?

What other tests to exclude

A

X-ray is normal
Exclude other causes - BG, TFT
Passive no better than active
Passive better if rotator cuff tear

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6
Q

What causes frozen shoulder / RF

A 
Idiopathic
Trauma
Periods of immobilisation 
F>M
DM / thyroid issues / cervical spondylosis
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7
Q

How do you Rx frozen shoulder

A

NSAID / analgesia
Steroid injection EARLY
Early physio
Surgery if late

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8
Q

What causes rotator cuff tear

A

Trauma in younger
Degeneration of supraspinatous
Repetitive lifting
Athletes

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9
Q

What are the Sx rotator cuff tear

A 
Pain not settling physio
Crepitus
Weakness
Worse on abduction up to 60 
Tenderness over anterior acromion
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10
Q

How do you Dx

A

USS sows tear

MRI show muscle wasting

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11
Q

What Is rotator cuff tear until proven otherwise

A

Pain not settling with physiology

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12
Q

How do you Rx

A

If acute / complete = surgical referral
Tears >2cm = surgical
Local steroid injection

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13
Q

What are rotator cuff muscles and role and where do they attach

A

Supraspinatous
Infraspinatous
Teres minor
Subscapularis

Stability of shoulder
Hold humerus against glenoid when deltoid abducts so may not be able to abduct even if deltoid fine

SIT = greater tuberosity of humerus 
Subscapularis = lesser tuberosity
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14
Q

What does supra do and what nerve

A

aBDucts with deltoid
Suprascapular nerve
Commonly injured as between aromion

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15
Q

What does infra do

A

Rotates laterally / external rotation

Suprascapular nerve

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16
Q

What does Teres do

A

Adducts
Rotates laterally / external rotation
Axillary

17
Q

What does subscapularis do

A

Adducts
Rotate medially / internal rotation with pec major
Subscapularis nerve

18
Q

What is action of deltoid

A 
Anterior = flexion + pec major 
Middle = abduction
Posterior = extension
19
Q

What are the symptoms of calcific tendonitis

A

Deposits of calcium phosphate in any tendon- commonly rotator cuff
Painful abduction
Tender to palpate
Inflammation of supraspinatous

20
Q

How do you Dx and Rx

A

X-ray will show calcification
Physio
ANalgesia
Steroid injection

21
Q

What is Medial epicondylitis. ‘Golfer’s elbow’

A

Tendinopathy / degeneration of flexor muscles to medial epicondyle

22
Q

What are the symptoms

A

Pain and tenderness over medial epicondyle
Worse on extension of elbow
Worse on wrist flexion / pronation
May have numb 4th + 5th fingers due to ulnar nerve

23
Q

What is Lateral epicondylitis tennis elbow)

A

Tendinopathy / degeneration of extensor muscles to lateral epicondyle

24
Q

What are the symptoms

A

Pain and tenderness over lateral epicondyle
Worse on flexion elbow (opposite to muscle inflamed)
Pain worse on resisted wrist extension

25
Q

How do you Rx

A 
RICE
Analgesia
Compression strap
Steroid injection 
Physio
26
Q

What is subluxation of radial head

A

Pulled elbow
Distal attachment of annular ligament covering radius is weak so pulled out
Usually when holding parents hand

27
Q

What are the symptoms

A

Elbow pain
Reluctance to move arm
Limited supination / pronation / extension of elbow
Arm slightly flexed and twisted in

28
Q

How do you Dx

A

Clinical

29
Q

How do you Rx

A

Analgesia
Reduce back in
Often hear click

30
Q

What causes olecranon bursitis

A

Mechanical / pressure on elbow
Gout
RA

31
Q

What are the symptoms

A 
Swelling 
Pain
Warmth
Erythem
ROM unaffected
32
Q

How do you Rx

A

NSAID
Rarely aspiration
Consider Ax if cellulitis

33
Q

What must you exclude

A

Septic bursitis

IV Ax and drainage

34
Q

What are symptoms to ask with shoulder pain

A 
Any neck pain 
Weakness
Swelling / bruising
Stiffness 
Systemic
35
Q

What does bilateral suggest

A

More systemic so ask features of this

36
Q

What should you always do with shoulder pain

A

Examine neck / ask if neck pain

37
Q

When do you X-ray

A

If system features

38
Q

When do you USS / MRI

A

If fails to settle

Looks for tears of rotator cuff

39
Q

Ddx elbow pain

A 
Fracture
OA
Bursitis 
RA 
Epicondyllitis
Tumour = rare 
Neuro - cubital tunnel or cervical spine injury 
Thoracic outlet

MSK (21 decks)

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